Payer Enrollment and Contracting Specialist

Job Overview & Responsibilities

The Payer Enrollment and Contracting Specialist provides critical administrative support to ensure our PT Solutions therapists and clinics are properly contracted and enrolled with commercial and government health insurance plans.  Additionally, they will act as a key support resource for the revenue cycle staff by proactively troubleshooting day-to-day issues to prevent reimbursement denials and optimize reimbursement.

Essential Functions

Contracting Support

• Serve as a revenue cycle resource for payer contract and fee schedule information to address staff questions about reimbursement and network participation.
• Navigate payer portals to research policies and procedures so that reimbursement problems may be resolved.
• Organize payer contracts and fee schedules in the contract management database in a logical manner.

Payer Enrollment

• Assist with successful completion of initial enrollment and re-validation for Commercial, Governmental and Workers Compensation payers.
• Serve as a liaison between clinic staff, revenue cycle and payer enrollment vendors to ensure timely payer enrollment.

Revenue Cycle Support

• Serve as a dedicated point of contact for patient access, billing and accounts receivable staff to address payer-related questions.
• Resolve enrollment and payer contract related roadblocks affecting patient access and reimbursement.

Day-to-Day Problem Solving

• Investigate and troubleshoot daily operational issues, such out of network status, incorrect payer/provider setups and system data mismatches.

Claim Payment Resolution

• Work closely with the Revenue Cycle team to research, analyze, and resolve claims denials specifically tied to enrollment or contracting errors.
• Collaborate with Revenue Cycle team to identify and successfully resolve underpayments.

Data Maintenance

• Update and maintain provider demographic data in internal systems and external databases.

Qualifications & Pay Range

Required Skills & Abilities

Payer Contracting

• Knowledge of commercial and governmental reimbursement methodologies and payer contract terms.
• Strong critical thinking and troubleshooting abilities to resolve payer contracting and enrollment obstacles independently.

Payer Enrollment

• Experience with professional credentialling and payer enrollment.
• Experience with CAQH, PECOS and payer enrollment software is highly desirable.

Team Collaboration

• A service-oriented mindset with the ability to effectively support and collaborate with revenue cycle colleagues.

Communication

• Strong verbal and written communication skills for professional interaction with clinical providers, revenue cycle leaders and insurance representatives.

Required Credentials

Education

• High School Diploma or equivalent required.
• Associate’s or bachelor’s degree in healthcare administration or a related field is a plus.

Experience

• 5-7 years of experience in a healthcare administrative setting, ideally within payer contracting, provider enrollment, or revenue cycle operations.

Military

• Service in the military is highly desirable.

Compensation:

• $60,000-70,000 annually (Any posted pay range considers a wide range of compensation factors, including candidate background, experience, and work location, while also allowing for salary growth within the position)

Company Overview

Expanding Access to Quality Care 

At PT Solutions, we’re more than colleagues; we’re a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training. 

As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact.  

Let’s go further together and transform care. Join the #PTSLife today!  

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